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Alfredo Altamirano, a Physicians Assistant at Prairie Medical Associates, Cheryl Kuhn of Morris Area Community Education, and Allen Monroe, a Doctor of Chiropractic, took part in a Learning Unlimited forum on health care earlier this month

Learning Unlimited and Morris Area Service Learning brought the healthcare debate home in its third annual intergenerational National Issues Forum.

In a program titled "Coping with the Cost of Health Care: How do We Pay for What We Need?", a panel of local experts assembled at the Morris Elementary School Concert Hall to share personal experiences and analysis.

The purpose of an intergenerational forum is to bring young students and older adult learners together to learn from each other as they discuss important issues of the day.

The panelists represented diverse sectors of the health care industry, but much of their message was the same: Health care costs are growing, regulations are increasingly complex and providers are forced to spend more time on paperwork than patient care while never fully recovering their costs.

Addressing the insurance industry's perspective, Paul Le Tendre, a State Farm agent, said that insurance companies favor comprehensive health care reform that would guarantee coverage for everyone. He outlined some of the barriers to universal coverage, noting that covering more people would spread out the costs, making insurance less expensive overall.

There are many components to how insurance is priced, however, including costly technologies and drugs, that have to be understood. State laws also limit the ability to compete. For example, State Farm cannot cover smokers in Minnesota, LeTendre said.

Susan Olson, Administrator of West Wind Village, said that nursing homes are the most regulated industry in the U.S. Olson cited guidelines which are, she said, analogous to not being able to choose what color socks to wear on any given day. Not only are costs pre-determined, but the government also regulates income and pay scales.

Minnesota is an equalization state - everybody pays the same, regardless of whether they are using private funds, Medicaid or some other source. But this isn't as easy as it sounds, Olson said.

The professional judgment of the nursing care facility is constrained by a database-driven intake assessment on each patient that determines reimbursement levels. The cost basis is basically room and board, then services required, she said.

But Medicare alone specifies 53 different levels of care, which in the end leaves the facility $25 to $35 a day in the red. On the upside, it's nearly impossible to be evicted from a nursing home - unlike an assisted living facility - for inability to pay, Olson said.

The general perception is that all physicians are very highly paid, but according to Dr. Joan Goering, of Stevens Community Medical Center, that is not the reason for the high cost of health care, she said.

Based on total health care costs in the U.S., reducing physician's salaries by 20 percent would result in only a 2 percent overall reduction in health care costs, she said.

Goering concentrated on the differences between doctors in private practice and "employed" physicians, which are those on contracted salaries. As a contractual employee, she also faces some very hard choices, particularly whether to ensure quality of care or to see as many patients as possible, she said.

Components of care include a patient's condition and the time spent with them. Then the bill is further determined by the quantity of documentation, which is then subject to contracts with numerous insurance agencies, Goering said.

There are many ironies at play; for example, specialized care is considered more reimbursable than time spent by a primary care physician, whereas more time spent with the family doctor who really knows the patient could have prevented the necessity of specialized care, Goering said.

As a practitioner, Allen Monroe, Doctor of Chiropractic, struggles with the same obstacles of predetermined decisions about patient care and reimbursements that haven't kept up with inflation. And as a small business owner, he is subject to additional levels of regulation.

Monroe stated that he doesn't want the federal government in the insurance business, in part because Medicare and Medicaid have not been good models. They have set costs and imposed other limitations to the extent that the doctor is required to do certain things but not all of them are reimbursable.

Fred Altamirano, a physician's assistant at Prairie Medical Associates ELEAH, picked up on many of the sentiments discussed, such as outside influences on how to practice medicine and the dilemma between the provider's passion for taking care of people and the headaches of paperwork.

Altamirano echoed Goering's assertion that most doctors are not rich; salaries are, however, commensurate with the level of education so that surgeon's salaries, for example, are higher than the family doctor's. Reimbursement should keep up with inflation or at least be relative to costs, he said.

Altamirano's personal experience highlighted some of the imbalances in the system - in the healing professions, the state requires proper credentialing, but even though he had already started in his new job here in Morris, delays in processing his documentation by the state meant that he worked without pay for several weeks.

While the panel agreed that once approved, actual care is good, the paperwork can be onerous and providers often have to fight with an insurance company that wants to second guess their professional judgment.

But some people are happy with their care and wondered if it's really that bad for others. Part of the answer is that rural areas may have an advantage when it comes to care, panelists said.

There is more flexibility in smaller communities where family connections are known and treatment models consider the whole person, unlike in larger urban areas where care may be driven solely by charts, tables and statistics.